|
Flexor 7Fr 45cm ANL0
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL1
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL1
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL1
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL2
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL2
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL2
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL3
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL3
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 7Fr 45cm ANL3
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 8Fr 45cm ANL0
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 8Fr 45cm ANL0
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 8Fr 45cm ANL0
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 8Fr 45cm ANL1
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 8Fr 45cm ANL1
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Flexor 8Fr 45cm ANL1
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
FLEX TOE SWANSON LATERAL 4260070
|
Facility
|
IP
|
$6,880.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
6181325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,371.20 |
| Max. Negotiated Rate |
$6,329.60 |
| Rate for Payer: Aetna Commercial |
$6,192.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,916.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.40
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,329.60
|
| Rate for Payer: Health EOS Commercial |
$6,123.20
|
| Rate for Payer: HFN Commercial |
$6,329.60
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,329.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.20
|
| Rate for Payer: Quartz Commercial |
$4,128.00
|
| Rate for Payer: WEA Trust Commercial |
$3,784.00
|
| Rate for Payer: WPS Commercial |
$5,096.02
|
|
|
FLEX TOE SWANSON LATERAL 4260070
|
Facility
|
OP
|
$6,880.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
6181325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,926.40 |
| Max. Negotiated Rate |
$27,520.00 |
| Rate for Payer: Aetna Commercial |
$6,192.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,916.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,926.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,472.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,440.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,302.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.40
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cigna Commercial |
$6,329.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,850.05
|
| Rate for Payer: Health EOS Commercial |
$6,123.20
|
| Rate for Payer: HFN Commercial |
$6,329.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,160.00
|
| Rate for Payer: Multiplan Commercial |
$5,504.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,329.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.20
|
| Rate for Payer: Quartz Commercial |
$4,472.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,128.00
|
| Rate for Payer: The Alliance Commercial |
$27,520.00
|
| Rate for Payer: WEA Trust Commercial |
$3,784.00
|
| Rate for Payer: WPS Commercial |
$5,096.02
|
|
|
FLEXTOME BALLOON 2.5 X 15 CBM325015
|
Facility
|
IP
|
$8,695.00
|
|
| Hospital Charge Code |
3072557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,260.55 |
| Max. Negotiated Rate |
$7,999.40 |
| Rate for Payer: Aetna Commercial |
$7,825.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.35
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$7,999.40
|
| Rate for Payer: Health EOS Commercial |
$7,738.55
|
| Rate for Payer: HFN Commercial |
$7,999.40
|
| Rate for Payer: Multiplan Commercial |
$6,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,217.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,999.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.55
|
| Rate for Payer: Quartz Commercial |
$5,217.00
|
| Rate for Payer: WEA Trust Commercial |
$4,782.25
|
| Rate for Payer: WPS Commercial |
$6,440.39
|
|
|
FLEXTOME BALLOON 2.5 X 15 CBM325015
|
Facility
|
OP
|
$8,695.00
|
|
| Hospital Charge Code |
3072557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,434.60 |
| Max. Negotiated Rate |
$34,780.00 |
| Rate for Payer: Aetna Commercial |
$7,825.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,434.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,651.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,347.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,173.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.35
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$7,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,865.72
|
| Rate for Payer: Health EOS Commercial |
$7,738.55
|
| Rate for Payer: HFN Commercial |
$7,999.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,521.25
|
| Rate for Payer: Multiplan Commercial |
$6,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,217.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,999.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.55
|
| Rate for Payer: Quartz Commercial |
$5,651.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,217.00
|
| Rate for Payer: The Alliance Commercial |
$34,780.00
|
| Rate for Payer: WEA Trust Commercial |
$4,782.25
|
| Rate for Payer: WPS Commercial |
$6,440.39
|
|
|
FLEXTOME BALLOON 4.0 X 10 CBM340010
|
Facility
|
OP
|
$8,695.00
|
|
| Hospital Charge Code |
3072556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,434.60 |
| Max. Negotiated Rate |
$34,780.00 |
| Rate for Payer: Aetna Commercial |
$7,825.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,434.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,651.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,347.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,173.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.35
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$7,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,865.72
|
| Rate for Payer: Health EOS Commercial |
$7,738.55
|
| Rate for Payer: HFN Commercial |
$7,999.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,521.25
|
| Rate for Payer: Multiplan Commercial |
$6,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,217.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,999.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.55
|
| Rate for Payer: Quartz Commercial |
$5,651.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,217.00
|
| Rate for Payer: The Alliance Commercial |
$34,780.00
|
| Rate for Payer: WEA Trust Commercial |
$4,782.25
|
| Rate for Payer: WPS Commercial |
$6,440.39
|
|
|
FLEXTOME BALLOON 4.0 X 10 CBM340010
|
Facility
|
IP
|
$8,695.00
|
|
| Hospital Charge Code |
3072556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,260.55 |
| Max. Negotiated Rate |
$7,999.40 |
| Rate for Payer: Aetna Commercial |
$7,825.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.35
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$7,999.40
|
| Rate for Payer: Health EOS Commercial |
$7,738.55
|
| Rate for Payer: HFN Commercial |
$7,999.40
|
| Rate for Payer: Multiplan Commercial |
$6,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,217.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,999.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.55
|
| Rate for Payer: Quartz Commercial |
$5,217.00
|
| Rate for Payer: WEA Trust Commercial |
$4,782.25
|
| Rate for Payer: WPS Commercial |
$6,440.39
|
|
|
FLEXTOME BALLOON 4.0 X 15 CBM340015
|
Facility
|
IP
|
$8,695.00
|
|
| Hospital Charge Code |
3072558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,260.55 |
| Max. Negotiated Rate |
$7,999.40 |
| Rate for Payer: Aetna Commercial |
$7,825.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.35
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$7,999.40
|
| Rate for Payer: Health EOS Commercial |
$7,738.55
|
| Rate for Payer: HFN Commercial |
$7,999.40
|
| Rate for Payer: Multiplan Commercial |
$6,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,217.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,999.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.55
|
| Rate for Payer: Quartz Commercial |
$5,217.00
|
| Rate for Payer: WEA Trust Commercial |
$4,782.25
|
| Rate for Payer: WPS Commercial |
$6,440.39
|
|
|
FLEXTOME BALLOON 4.0 X 15 CBM340015
|
Facility
|
OP
|
$8,695.00
|
|
| Hospital Charge Code |
3072558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,434.60 |
| Max. Negotiated Rate |
$34,780.00 |
| Rate for Payer: Aetna Commercial |
$7,825.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,434.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,651.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,347.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,173.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.35
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$7,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,865.72
|
| Rate for Payer: Health EOS Commercial |
$7,738.55
|
| Rate for Payer: HFN Commercial |
$7,999.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,521.25
|
| Rate for Payer: Multiplan Commercial |
$6,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,217.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,999.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.55
|
| Rate for Payer: Quartz Commercial |
$5,651.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,217.00
|
| Rate for Payer: The Alliance Commercial |
$34,780.00
|
| Rate for Payer: WEA Trust Commercial |
$4,782.25
|
| Rate for Payer: WPS Commercial |
$6,440.39
|
|
|
FLIP CUTTER II 10.0MM AR-1204AF-100
|
Facility
|
OP
|
$5,894.00
|
|
| Hospital Charge Code |
2964677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,650.32 |
| Max. Negotiated Rate |
$23,576.00 |
| Rate for Payer: Aetna Commercial |
$5,304.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,068.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,650.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,831.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,947.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,829.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,123.82
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,422.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,298.28
|
| Rate for Payer: Health EOS Commercial |
$5,245.66
|
| Rate for Payer: HFN Commercial |
$5,422.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,420.50
|
| Rate for Payer: Multiplan Commercial |
$4,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,536.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,422.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,888.06
|
| Rate for Payer: Quartz Commercial |
$3,831.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,536.40
|
| Rate for Payer: The Alliance Commercial |
$23,576.00
|
| Rate for Payer: WEA Trust Commercial |
$3,241.70
|
| Rate for Payer: WPS Commercial |
$4,365.69
|
|
